The management of scabies outbreaks in residential care facilities for the elderly in England: a review of current health protection guidelines.

Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.

Scuba diving with diabetes mellitus--the UK experience 1991-2001.

OBJECTIVES: To survey the outcomes and practises of divers with diabetes mellitus. METHODS: Diabetic persons wishing to learn to scuba-dive or established divers who have diabetes mellitus in the UK are requested to fill in a detailed questionnaire annually. Divers are asked to provide basic epidemiological information and general diving history. Data provided by the diver's diabetic physician provided independent evidence of the diver's medical status. These data are recorded and analysed. RESULTS: Data have been gathered from 323 diabetic divers (269 male, 54 female) and 8,760 dives have been recorded over 11 years. Two fatalities were reported, both in non-insulin dependent divers. One incident of hypoglycaemia underwater in an insulin dependent diabetic diver has been reported. CONCLUSIONS: This survey showed that in the group of well-controlled diabetic divers studied, there were no serious problems due to hypoglycaemia when they dived. Long-term complications of diabetes must be excluded before a diabetic diver may be permitted to dive.

Survival of microvascular free flaps in head and neck surgery after early interruption of the vascular pedicle.

Six to nineteen days after insertion of free flaps in oral defects three patients had secondary haemorrhages that necessitated the abolition of venous drainage in two cases and venous and arterial connections in the third. The flaps survived.

Selectins--glycoprotein targets for therapeutic intervention in inflammation.

Inflammation can be a beneficial response in the host for the control of infection and injury. However, occasionally, the inflammatory response can result in acute systemic collapse or, more frequently, a chronic reaction such as that observed in autoimmune disease, Crohn's disease and asthma. Injury to tissues or organs results in leukocyte adhesion to the endothelial cell surface, followed by diapedesis. Investigation of the initial leukocyte-endothelium adhesion processes has clearly shown the involvement of an inducible set of molecules, called selectins, on the endothelial and leukocyte cell surfaces. These molecules are of interest as the interactions with their respective ligands appear to involve carbohydrates. The exact nature of these interactions is still being elucidated. Therapeutic intervention using carbohydrate small-molecule mimetics may be beneficial in the modification of the inflammatory process.

Synthesis and smooth muscle relaxant activity of a new series of potassium channel activators: 3-amido-1,1-dimethylindan-2-ols.

The synthesis of a novel series of smooth muscle relaxants which have been shown to act via the opening or activation of potassium channels is described. Compounds have been evaluated for their ability to inhibit spontaneous tone in guinea pig isolated trachealis and structure-activity relationships are discussed. One compound in particular, 1,1-dimethyl-5-nitro-3-(2-pyridon-1-yl)indan-2-ol, (16) was identified as a potent relaxant of airways smooth muscle in vitro with IC50 = 0.15 microM and was found to significantly inhibit histamine-induced dyspnoea in conscious guinea pigs when given orally 30-45 min prior to challenge.

Short communication: selective placental transport of maternal IgG to the fetus.

During pregnancy there is a dramatic reduction in the serum levels of agalactosyl IgG (G0IgG) in both normal women and those with rheumatoid arthritis. In order to determine if a similar reduction in G0IgG were apparent in fetal serum, a comparison of the galactose content of IgG from nine paired samples of umbilical vein or fetal blood and peripheral maternal serum, at gestational ages ranging from 16-41 weeks was performed. The full-term maternal IgG samples were highly galactosylated, so confirming previous observations of reduced G0IgG levels during pregnancy. In addition every paired sample of fetal IgG had a higher level of galactosylation than the corresponding maternal IgG. Therefore, during pregnancy there is both a reduced biosynthesis of the G0IgG glycoform by the mother, and a restriction of its transport across the placenta. The ratio of estimated G0IgG in fetal and maternal serum was found to be related to changes in IgG transport, and in particular the active transport of IgG1 across the placenta during gestation. Our data suggest that the placental IgG transport mechanism is either carbohydrate independent by discriminating for IgG1, or is carbohydrate dependent selecting for highly galactosylated IgG glycoforms. This study emphasizes the need for further investigations on the biological function of G0IgG in normal physiological states, in addition to disease states, such as juvenile and adult rheumatoid arthritis, where elevated G0IgG levels correlate with disease activity.

Neuron-specific localisation of the TR3 death receptor in Alzheimer's disease.

Death receptors are associated with the homeostatic and pathologic induction of cell death. TR3 is a recently characterised member of the death receptor family that is expressed in the adult brain. In order to establish the role of TR3 in acute CNS disease and chronic neurodegeneration, we analysed brain regions from Alzheimer's disease (AD), stroke and neurotrauma patients, using a novel anti-peptide antibody generated to an exposed epitope in the extracellular domain of the receptor. We show a statistically significant increase in TR3 protein levels in AD brain samples but not in stroke, neurotrauma or control samples. The increase observed for TR3 was specific to neurons in regions associated with AD pathology. This is the first report describing the neuron-specific regulation of a death receptor in chronic disease and may indicate that a TR3 receptor-mediated signalling pathway is involved in AD-associated neuronal loss.

Oligosaccharide sequencing based on exo- and endoglycosidase digestion and liquid chromatographic analysis of the products.

Exo- and endoglycosidases are used to sequence oligosaccharides and give valuable information on the monosaccharide sequence, together with the anomericity, the stereochemistry, and in some cases, the substitution pattern of the monosaccharides. Both sequential and parallel methods of oligosaccharide sequencing are discussed.

Uncertainties in structural determinations of oligosaccharide conformation, using measurements of nuclear Overhauser effects.

A fundamental problem in the determination of molecular structure by n.m.r. spectroscopy is insufficient experimental constraints. This problem is particularly marked for oligosaccharides, where few constraints are available across glycosidic linkages. By calculating distances as a function of dihedral angle, it is shown that, in general, two n.O.e. constraints result in two possible conformations for each glycosidic linkage, one of which can usually be discarded on the basis of model building or energy calculations. Using these calculations, an estimate of the uncertainty in the structure can be obtained.

Increasing concentrations of nitrogen dioxide pollution in rural Wales.

Monitoring of nitrogen dioxide pollution was carried out in rural environments throughout Wales during a 1-year survey to quantify any changes in background concentrations and distribution of the pollutant since an earlier survey in 1986. There were 23 sites in the present survey of which 16 had been monitored during the 1986 survey. The remaining 7 sites were based on moorland in mid-Wales within map squares for which critical loads for soil acidification are expected to be exceeded by the year 2005. All sites were chosen so as to be remote from major local sources of NO(2) and the values obtained were deemed to be minimum concentrations for the different regions. Measurements were made using diffusion tubes which aimed to provide mean concentrations of NO(2) for 2-week exposure periods. Concentrations of NO(2) were found to be higher in the winter months for most sites and this is probably related to a greater use of fossil fuels for heating buildings at this time of year. The exception was the high concentrations of NO(2) in May and June for several sites in North Wales, and in July and August for a site on Mount Snowdon. These high summer concentrations in North Wales are thought to be related to increased traffic associated with tourism. It is apparent that there has been a substantial increase in rural concentrations of NO(2) throughout Wales since the earlier survey of 1986. As an average of all 16 sites used in both surveys, there was a 53% increase in the annual mean concentration of NO(2). Also, it is evident that, since 1986, there has been a substantial increase in the area of south-eastern Wales which has a background level in excess of 10 ppb NO(2) and a notable reduction in land area with concentrations below 6 ppb NO(2) as an annual mean concentration. The possible future impact of increasing rural concentrations of NO(2) on Welsh vegetation is discussed with references to estimates of critical levels of NO(2) for adverse effects on plants.

Control of blood glucose in a group of diabetic scuba divers.

A preliminary study to examine the hypothesis that the ability of well-controlled (defined as no hypoglycemic episodes within the last 12 mo., HbAlc < 9.0%, and none of the long-term complications of diabetes type I) diabetic scuba divers to control their serum glucose and dive without becoming hypoglycemic during a simulated dive to 27 meters of seawater in controlled environment is impaired. An open, controlled, crossover study compared blood glucose levels, hematocrits, and hematologic cell counts in a group of eight type I diabetic scuba divers to those from eight age- and sex-matched, normoglycemic control scuba divers. Each diver did one simulated dive and one control exercise on the surface on 2 consecutive days. The simulated dive was done to depth of 375 kPa in a hyperbaric chamber, the control exercise was done at ambient pressure. The order of the dive and the control exercise was randomized. No statistically significant differences were observed between serum glucose levels in the diabetic divers measured during the simulated dive to 375 kPa vs. the serum glucose levels in the diabetic divers measured during the control exercise at the same time points. All divers with type I diabetes remained free of symptoms and signs of hypoglycemia throughout the course of the trial, and no diabetic subject had a serum glucose less than 4 mmol/liter before the end of the trial. As the sample size was small, larger studies including subject with type II diabetes will be necessary to extend these results to the diabetic diving population at large. The authors conclude that, contrary to advice issued by most diving agencies to scuba divers, it may be safe to allow well-controlled subjects with type I diabetes with no long-term complications to undertake scuba diving, and that high partial pressures of oxygen do not seem to lower serum glucose levels significantly in the diabetic diver during the dive.

Effects of pressure on whole blood glucose measurements using the Bayer Glucometer 4 blood glucose meter.

The effect of pressure was investigated on the readings of whole blood glucose obtained from the Bayer Glucometer 4 blood glucose meter which uses the hexokinase enzymatic reaction. Sixteen subjects (eight normal and eight insulin-dependent diabetics) were exercised in a hyperbaric chamber at a depth of 3.7 atm abs. Venous blood samples were monitored at regular intervals for whole blood glucose concentration as measured by a Glucometer 4 inside the chamber. The blood samples were immediately placed in an airlock and taken to 1 atm abs, where whole blood glucose concentrations were measured using an identical instrument. The remaining blood was then analyzed in duplicate for serum glucose concentration using standard laboratory methods. The results show a significant difference between whole blood glucose concentrations measured at pressure and those measured at atmospheric pressure. Significant differences are also observed between whole blood glucose concentrations measured under pressure and serum blood glucose concentrations measured at atmospheric pressure.

Photodynamic therapy and the treatment of head and neck cancer.

An account is given of how Photodynamic Therapy (PDT) may be used in the diagnosis and treatment of cancer of the head and neck. The role and mode of action of the tumour sensitising agent, Haematoporphyrin derivative (HPD), are shown and the current use of lasers as suitable light sources will be discussed. Individual cases are used to illustrate the current state of this form of treatment and an indication of future developments is provided.

Complications of pharyngostomy.

An account is given of a fatal complication following the use of a pharyngostomy feeding tube. The literature on this topic is reviewed with regard to complications. Of the 671 patients that have been reported previously there have been no fatal or serious complications and minor complications were reported in only 42 patients. We regard the technique of pharyngostomy to be safe but recommendations are made to avoid the complication reported here.

Effects of the glyphosate-based herbicide Roundup WeatherMax® on metamorphosis of wood frogs (Lithobates sylvaticus) in natural wetlands.

Amphibian tadpoles develop in aquatic environments where they are susceptible to the effects of pesticides and other environmental contaminants. Glyphosate-based herbicides are currently the most commonly used herbicide in the world and have been shown to affect survival and development of tadpoles under laboratory and mesocosm conditions. In the present study, whole wetland manipulations were used to determine if exposure to an agriculturally relevant application of Roundup WeatherMax(®), a herbicide formulation containing the potassium salt of glyphosate and an undisclosed surfactant, influences the development of wood frog tadpoles (Lithobates sylvaticus) under natural conditions. Wetlands were divided in half with an impermeable curtain so that each wetland contained a treatment and control side. Tadpoles were exposed to two pulses of this herbicide at an environmentally realistic concentration (ERC, 0.21 mg acid equivalent (a.e.)/L) and the predicted maximum environmental concentration (PMEC, 2.89 mg a.e./L), after which abundance, growth, development, and mRNA levels of genes involved in tadpole metamorphosis were measured. Results present little evidence that exposure to this herbicide affects abundance, growth and development of wood frog tadpoles. As part of the Long-term Experimental Wetlands Area (LEWA) project, this research demonstrates that typical agricultural use of Roundup WeatherMax(®) poses minimal risk to larval amphibian development. However, our gene expression data (mRNA levels) suggests that glyphosate-based herbicides have the potential to alter hormonal pathways during tadpole development.